Healthcare Provider Details

I. General information

NPI: 1841511300
Provider Name (Legal Business Name): JOSE ALBERTO LOPEZ PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MAIN ST
BRAWLEY CA
92227-2244
US

IV. Provider business mailing address

71937 ELEANORA LANE
RANCHO MIRAGE CA
92270
US

V. Phone/Fax

Practice location:
  • Phone: 760-344-5732
  • Fax:
Mailing address:
  • Phone: 760-344-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: